Department of Surgery, Catharina Hospital Eindhoven, the Netherlands.
Department of Surgery, Catharina Hospital Eindhoven, the Netherlands.
Eur J Surg Oncol. 2020 Aug;46(8):1471-1476. doi: 10.1016/j.ejso.2020.04.035. Epub 2020 Apr 23.
The incidence and clinical significance of multifocality in ipsilateral breast tumor recurrence (IBTR) after breast-conserving therapy (BCT) are unclear. With growing interest in repeat BCT, this information has become of importance. This study aimed to gain insight in the incidence of multifocality in IBTR, to identify patient- and tumor-related predicting factors and to investigate the prognostic significance of multifocality.
Two hundred and fifteen patients were included in this analysis. All had an IBTR after BCT and were treated by salvage mastectomy and appropriate adjuvant therapy. Predictive tumor- and patient-related factors for multifocality in IBTR were identified using X2 test and univariate logistic regression analyses. Prognostic outcomes were calculated using Kaplan Meier analysis and compared using the log rank test.
Multifocality was present in 50 (22.9%) of IBTR mastectomy specimens. Axillary positivity in IBTR was significantly associated with multifocality in IBTR. Chest wall re-recurrences occurred more often after multifocal IBTR (14% versus 7% after unifocal IBTR, p = 0.120). Regional re-recurrences did not differ significantly between unifocal and multifocal IBTR (8% vs. 6%, p = 0.773). Distant metastasis after salvage surgery occurred more frequently after multifocal IBTR (15% vs. 24%, p = 0.122). Overall survival was 132 months after unifocal IBTR and 112 months after multifocal IBTR (p = 0.197).
The prevalence of multifocality in IBTR is higher than in primary breast cancer. Axillary positivity in IBTR was associated with a multifocal IBTR. Chest wall re-recurrences and distant metastasis were, although not statistically significant, more prevalent after multifocal IBTR.
保乳治疗（BCT）后同侧乳房肿瘤复发（IBTR）的多灶性的发生率和临床意义尚不清楚。随着对重复 BCT 兴趣的增加，这些信息变得越来越重要。本研究旨在深入了解 IBTR 多灶性的发生率，确定与患者和肿瘤相关的预测因素，并探讨多灶性的预后意义。
本分析纳入了 215 例患者。所有患者均在 BCT 后发生 IBTR，并接受挽救性乳房切除术和适当的辅助治疗。使用 X2 检验和单因素逻辑回归分析确定与 IBTR 多灶性相关的预测性肿瘤和患者相关因素。使用 Kaplan-Meier 分析计算预后结果，并使用对数秩检验进行比较。
50 例（22.9%）IBTR 乳房切除标本存在多灶性。IBTR 中的腋窝阳性与 IBTR 中的多灶性显著相关。多灶性 IBTR 后更常发生胸壁再复发（14%比单灶性 IBTR 的 7%，p=0.120）。多灶性和单灶性 IBTR 之间的区域再复发无显著差异（8%比 6%，p=0.773）。挽救手术后远处转移在多灶性 IBTR 后更频繁发生（15%比 24%，p=0.122）。单灶性 IBTR 后的总生存时间为 132 个月，多灶性 IBTR 后的总生存时间为 112 个月（p=0.197）。
IBTR 多灶性的发生率高于原发性乳腺癌。IBTR 中的腋窝阳性与 IBTR 的多灶性相关。尽管无统计学意义，但多灶性 IBTR 后胸壁再复发和远处转移更常见。
